The number of deaths from C-sections increased by 63% between 2008 and 2014, according to the latest issue of the South African Medical Journal.

The causes for this increase include poor skills among junior and inexperienced doctors, particularly those in rural under-resourced areas where they perform emergency or unnecessary caesarean sections. The report says these doctors will perform C-sections without supervision or proper obstetric/anaesthetic care.

Other reasons are “delays in calling for help with ongoing bleeding, inappropriate discharges from post-theatre recovery, and poor monitoring in postnatal wards.”

The number of C-sections performed in this country is abnormally high. The South African Council for Medical Schemes estimates that 70% of all births in private hospitals are done via caesarean section.

This is a high number considering that according to World Health Organisation (WHO) recommendations, the ideal rate for caesarean sections is between 10% and 15%.

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“Caesarean sections have become increasingly common in both developed and developing countries. When medically justified, a caesarean section can effectively prevent maternal and perinatal mortality and morbidity. However, there is no evidence showing the benefits of caesarean delivery for women or infants who do not require the procedure,” the WHO says.

Lana Petersen, who has been a doula* for over 12 years, and facilitates home births says some women have elective caesareans because they have been scared into it.

“There is a lot of fear-mongering around birth these days. People are told things like: “The baby is too big and we will have to break the shoulder”. This is how obstetricians talk about resolving the issue,” she explains.

Some women are told that if they have a natural vaginal birth they will ruin their pelvic floor muscles and their sex lives. The threat of becoming incontinent is also bandied about, explains Petersen.

The WHO warns, however, that caesarean sections are associated with short- and long-term risk which can extend many years beyond the delivery and affect the health and fertility of the woman. It can also affect the child.

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Petersen agrees, saying that a number of women are not warned of the problems that can arise after an unnecessary caesarean.

“What we are seeing is that women are being coerced and bullied into caesareans that they don’t want and most importantly don’t need. And they are not told when they are having their first caesarean that you increase your risk of infertility and increase your risk of placental abnormality. And yet doctors say it’s a safe procedure,” she says.

Petersen says women with healthy pregnancies can consult midwives who will provide them with additional complementary maternal care.

“For women with healthy pregnancies, the first port of call will be obstetricians. Obstetrics is the practice of abnormal pregnancy and birth, so in fact they should be seeing midwives who specialise in natural birth,” she advises.

Additional reporting: World Health Organisation